Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases

Naftel, Robert P.; Argo, Joshua L.; Shannon, Chevis N.; Taylor, Tracy H.; Tubbs, R. Shane; Clements, Ronald H.; Harrigan, Mark R.

doi:10.3171/2011.1.jns101492

Cited by 82 publications

(77 citation statements)

References 43 publications

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“…Others, however, have demonstrated a reduction in distal catheter failure rate when the distal peritoneal catheter was placed lapa roscopically as opposed to via minilaparotomy. 7 Further more, there is some data to suggest that the use of pro grammable valves reduces shunt failure/revision.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation

Wilson¹,

Stetler²,

Al-Holou³

et al. 2013

JNS

120

108

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Object. The objective of this study was to compare the accuracy of 3 methods of ventricular catheter placement during CSF shunt operations: the freehand technique using surface anatomy, ultrasonic guidance, and stereotactic neuronavigation.Methods. This retrospective cohort study included all patients from a single institution who underwent a ven tricular CSF shunting procedure in which a new ventricular catheter was placed between January 2005 and March 2010. Data abstracted for each patient included age, sex, diagnosis, method of ventricular catheter placement, site and side of ventricular catheter placement, Evans ratio, and bifrontal ventricular span. Postoperative radiographic stud ies were reviewed for accuracy of ventricular catheter placement. Medical records were also reviewed for evidence of shunt failure requiring revision through December 2011. Statistical analysis was then performed comparing the 3 methods of ventricular catheter placement and to determine risk factors for inaccurate placement.Results. There were 249 patients included in the study; 170 ventricular catheters were freehand passed, 51 were placed using stereotactic neuronavigation, and 28 were placed under intraoperative ultrasonic guidance. There was a statistically significant difference between freehand catheters and stereotactic-guided catheters (p < 0.001), as well as between freehand catheters and ultrasound-guided catheters (p < 0.001). The only risk factor for inaccurate place ment identified in this study was use of the freehand technique. The use of stereotactic neuronavigation and ultrasonic guidance reduced proximal shunt failure rates (p < 0.05) in comparison with a freehand technique.Conclusions. Stereotactic-and ultrasound-guided ventricular catheter placements are significantly more accu rate than freehand placement, and the use of these intraoperative guidance techniques reduced proximal shunt failure in this study.

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Section: Discussionmentioning

confidence: 99%

Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation

Wilson¹,

Stetler²,

Al-Holou³

et al. 2013

JNS

120

108

View full text Add to dashboard Cite

show abstract

“…This difference can be attributed to the difference in the follow up period, the type of the system and the age of the patients in each study. requires minilaparotomy with abdominal incision and muscle dissection to reach our target, which is the intra peritoneal space (7,9,20). During shunt revisions we usually make revision for the peritoneal end by externalizing the tube and checking for CSF flow which are considered diagnostic and therapeutic procedures and only do cranial revision if there is no CSF flow from the peritoneal end to avoid the unneeded exposure of the reservoir or the brain and decrease the related complications.…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic assisted shunting procedures are considered an alternative to the traditional laparotomy technique to insert the distal catheter and may improve the outcome of shunting procedures by accurate evaluation and management of the distal end of peritoneal catheter especially in patients with previous revisions, abdominal adhesions or cerebrospinal fluid pseudocysts (7,9,14,17,20,24,31).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic revision of the distally obstructed ventriculoperitoneal shunt

Abouhashem

Taha²,

Ismail³

et al. 2012

Turkish Neurosurgery

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AIm: Evaluation of the laparoscopic assisted revision of the ventriculoperitoneal shunt as an alternative technique to the traditional laparotomy. mAterIAl and methOds: Out of 1181 elective neurosurgical procedures have been done from January 2009 to December 2010. There are 98 (8.2%) ventriculoperitoneal shunt procedures. New shunt insertion was performed 41 times (41.9%) and shunt revision performed 57 times (58.1%). Shunt-related infection was detected in 11 cases (11.22%) while mechanical failure was found in 46 cases (46.9%), proximal obstruction was diagnosed in 26 cases (26.5 %) while 20 patients (20.4%) suffered from distal obstruction. Out of the 20 patients with distal obstruction, 12 patients were treated with laparoscopic assisted revision of the peritoneal end.results: Intra operative finding revealed peritoneal adhesion in 83.3% of cases and cerebrospinal fluid pseudo cyst in 16.6% while extra peritoneal tube was found in one case. Intraoperative management included adhesiolysis in 10 patient, evacuation and marsupialization of the cyst in two cases in addition to tube repositioning in all cases. There was no procedure-related complications.COnClusIOn: Laparoscopic assisted revision of the peritoneal catheter is an alternative technique to traditional laparotomy in the revision of ventriculoperitoneal shunt.

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“…However, despite the fact that it is considered a minor invasive procedure, it does involve certain risks, such as hemorrhage, shunt malfunction, or infection (19)(20)(21); in addition, it may rarely result in peritoneal carcinomatosis due to seeding from the central nervous system (CNS) tumors (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Nevertheless, not all studies have encountered peritoneal seeding via VPS (16,30,40).…”

Section: Introductionmentioning

confidence: 99%

Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases

Nigim

Critchlow

Kasper

2015

Molecular and Clinical Oncology

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Abstract. Approximately 1-5% of patients with cerebral metastasis and ~40% of patients with primary brain tumors suffer from hydrocephalus. These patients often exhibit a poor prognosis. The aim of the present study was to reassess the validity of ventriculoperitoneal shunting (VPS) with the assistance of the general surgeon in oncological patients. A total of 59 patients underwent first-time VPS at the Beth Israel Deaconess Medical Center (Boston, USA) between 2004 and 2012; 40 patients had hydrocephalus from brain metastasis and 19 from primary tumors. The analyzed independent variables included demographics, body mass index, past medical history, clinical presentation, indication for surgery, Karnofsky performance status (KPS) score and surgical technique; the dependent variables were postoperative symptoms and occurrence, cause and time of shunt failure. The outcomes were analyzed with the t-test and Kaplan-Meier estimates for shunt survival. The mean age of the patients was 57.2 years and the mean operative time was 50.4 min. Symptomatic palliation was achieved in 93% of the cases; patients with severe symptoms, such as debilitating headaches, nausea and vomiting, benefited significantly from VPS. The mean follow-up time was 6.3 months; complications occurred in only 7 patients (11.8%) during follow-up: 2 in the proximal shunt (1 infection and 1 obstruction), both requiring revision, 1 infection in the distal catheter requiring shunt removal, 2 cases of intracerebral bleeding that were monitored with computed tomography scans, 1 wound infection treated with antibiotics and 1 valve complication that required temporary revision. The initial and 3-month KPS scores were 65±16.4 and 75±16.0, respectively. The mean overall shunt survival was 6.4 months (range, 1.0 day-76.0 months) from the placement of the VP shunt. At 3 months after VPS, 93.5% of the patients remained alive with functioning shunts and at 1 year 87% of the shunts were still functioning. In conclusion, VPS remains a valid option for cancer patients with low KPS, as it improves the quality of life in such patients, even in the setting of previous infection, hemorrhage, or leptomeningeal disease, since shunt patency outlasts the overall survival of nearly all patients.

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Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases

Cited by 82 publications

References 43 publications

Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation

Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation

Laparoscopic revision of the distally obstructed ventriculoperitoneal shunt

Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases

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